Outcomes and Implementation Strategies From the First U.S. Evidence-Based Practice Leadership Summit

Commentary

Outcomes and Implementation StrategiesFrom the First U.S. Evidence-BasedPractice Leadership Summit

Bernadette Mazurek Melnyk, RN, PhD, CPNP/NPP, FAAN, FNAP, Ellen Fineout-Overholt, RN, PhD, Cheryl Stetler, RN, PhD,Janet Allan, RN, PhD, CS, FAAN

Initiatives are being undertaken to advance evidence-based practice (EBP) in health care and professional

organizations, as well as in educational institutionsthroughout the United States and across the globe, as itis known that evidence-based care leads to better out-comes than health care that is steeped in tradition (Heateret al. 1988; Melnyk & Fineout-Overholt 2005). Addition-ally, there is some evidence to indicate that health pro-fessionals who use an evidence-based approach to theircare report higher levels of satisfaction than those whodeliver care that is not based upon evidence from well-designed studies (Dawes 1996). However, progress remainsslow as only a small percentage of clinicians are imple-menting evidence-based care and following EBP guidelines(Cretin et al. 2001; Jolley 2002; Melnyk et al. 2004) de-spite the fact that Rule 5 of the 10 rules for health care inthe United State’s Crossing the Quality Chasm is evidence-based decision making (Committee on Quality of HealthCare in America 2001) and one of the five core competen-cies deemed necessary by the recent Institute of Medicine’sHealth Professions Educational Summit includes “employ-ing evidence-based practice” (Greiner & Knebel 2003).

Multiple barriers have impeded the advancement ofEBP. Some of these barriers include (a) limited fundingfor translational research and EBP implementation projects(Thompson 2004); (b) lack of administrative support; (c)misperceptions about EBP (e.g., it is too time consuming);(d) lack of national/international coordination to develop,implement, evaluate, and update clinical practice guide-

Bernadette Mazurek Melnyk, Dean and Distinguished Foundation Professor in Nursing,College of Nursing, Arizona State University, Tempe, Arizona. Ellen Fineout-Overholt,Director, Center for the Advancement of Evidence-Based Practice, College of Nursing,Arizona State University, Tempe, Arizona. Cheryl Stetler, Consultant in EBP, Amherst,Massachusetts. Janet Allan, Dean and Professor, University of Maryland School ofNursing, Baltimore, Maryland.

Address correspondence to Bernadette Mazurek Melnyk, RN, PhD, CPNP/NPP,FAAN, FNAP, Dean and Distinguished Foundation Professor in Nursing, Collegeof Nursing, Arizona State University, Tempe, Arizona; [email protected]

Copyright ©2005 Sigma Theta Tau International1545-102X1/05

lines (Wallin & Ehrenberg, 2004); (e) inadequate supportfrom key leaders in health care organizations; (f) insuffi-cient numbers of experts/mentors to lead EBP initiatives;(g) lack of resources for continuing education and skillsbuilding; (h) conferences that are only didactic in nature;(i) lack of master’s and doctorally prepared nurses in somecountries (e.g., Sweden; Wallin & Ehrenberg 2004); and(j) inadequate EBP knowledge, beliefs, and skills (Melnyket al. 2004). There also is a paucity of clinical trials thathave attempted to develop and test interventions to en-hance evidence-based nursing care. In addition, althoughthere has been a rapid proliferation of nursing studies overthe past three decades that have been building a sciencebase for nursing, systematic reviews are not yet common-place in the profession due, in large part, to the lack ofmultiple studies that attempt to describe, explain, or pre-dict similar phenomena. Furthermore, randomized con-trolled trials (RCTs) that could provide evidence to guidebest nursing practices are not the dominant methodologyused in nursing research.

In contrast, several facilitators to advancing EBP havebeen identified. Major factors include (a) championswithin an environment (i.e., those individuals who leadand advocate for EBP change within a system); (b) ad-ministrative support; (c) time and resources; (d) part-nerships between academic and clinical settings (Melnyk& Fineout-Overholt 2002); and (e) clearly written re-search reports (Omery & Williams 1999). In addition, hav-ing an “EBP mentor” has been identified in the ARCC(Advancing Research and Clinical practice through closeCollaboration) model as a critical factor in facilitatingevidence-based care (Melnyk & Fineout-Overholt 2002;Melnyk et al. 2004).

To develop a strategic plan and action initiatives torapidly accelerate EBP throughout the United States, an in-vitational leadership summit was held in conjunction withthe fifth national EBP conference, Translating Research IntoBest Practice With Vulnerable Populations. This annual con-ference is held with the specific aims of (a) accelerating therate at which research findings are integrated into clinical

Worldviews on Evidence-Based Nursing �Third Quarter 2005 113

Outcomes and Implementation Strategies

practice, to improve patient care and outcomes, (b) pro-viding educational–behavioral skills workshops for healthcare providers on the steps of evidence-based care, and (c)providing strategies on how best to teach EBP in curricu-lums and health care settings. Throughout the years, theconference has received funding support from the Agencyfor Healthcare Research and Quality (AHRQ) as well asfrom the Helene Fuld Health Trust, HSBC Bank, UnitedStates and has been co-sponsored by Sigma Theta Tau In-ternational, The Joanna Briggs Institute of Australia, theNew York State Nurses Association, and a number of uni-versities/colleges and health care organizations.

The EBP Leadership Summit was held on June 4, 2004,in Buffalo, New York. The primary purposes of the sum-mit were to (a) create a partnership/consortium to ad-vance EBP throughout the United States, (b) identify ad-ditional key partners for the consortium, (c) produce na-tional recommendations/goals to advance EBP in healthcare organizations and educational institutions, (d) iden-tify the top three innovative strategies/initiatives for theaccomplishment of the goals/recommendations, (e) iden-tify potential funding sources for the new EBP initia-tives, and (f) build infrastructure for future EBP specialtysummits.

Summit participants are listed in Table 1, and the pro-cess used for conducting the summit and disseminatingits recommendations is outlined in Table 2. Much of thesummit’s work was accomplished through small workinggroups that were charged with developing (a) priorities andstrategies to accelerate the translation of clinical researchfindings into practice, (b) priorities for synthesizing clin-ical research findings, (c) priorities for clinical research,and (d) strategies for overcoming barriers to implementingEBP. Highlights from the discussions of these four work-ing groups and recommendations from each group are pre-sented in Table 3.

PRIORITIES AND STRATEGIES TOACCELERATE THE TRANSLATION OF

CLINICAL RESEARCH FINDINGS INTOPRACTICE

Progress in accelerating research into practice requires (a)true partnership between nurse researchers and nurse exec-utives, grounded in the needs of patients and based on bestavailable evidence, and (b) better use of current scienceregarding organizational development and change relatedto EBP. There is a need to enhance institutionalization ofEBP (i.e., to make EBP the “norm”). To accomplish thisgoal, health care leaders should be educated on how tocreate an infrastructure and culture to support EBP. Unfor-tunately, there are no magic bullets available to ensure the

TABLE 1EBP experts, health care leaders, and researchers participating inthe summitMichael Ackerman, RN, DNS, FCCM, FNAP

Professor of Clinical Nursing and DirectorCenter for Clinical Trials and Medical Device EvaluationUniversity of Rochester School of NursingRochester, New York

Janet Allan, RN, PhD, CS, FAANDean and ProfessorUniversity of Maryland School of NursingVice-Chair, U.S. Preventive Services Task ForceBaltimore, Maryland

Donna Ciliska, RN, PhDProfessor, School of NursingMcMaster UniversityOntario, Canada

Margaret Coopey, RN, MGA, MPSSenior Health Policy AnalystAgency for Healthcare Research and QualityRockville, Maryland

Linda Finke, RN, PhDDirector, Professional Development CenterHonor Society of Nursing, Sigma Theta Tau InternationalIndianapolis, Indiana

Ellen Fineout-Overholt, RN, PhDDirector, Center for the Advancement of Evidence-Based PracticeCollege of NursingArizona State UniversityTempe, Arizona

Christine R. Kovach, RN, PhDProfessor and Center ScientistCollege of NursingUniversity of Wisconsin – MilwaukeeMilwaukee, Wisconsin

Bernadette Mazurek Melnyk, RN, PhD, CPNP/NPP, FAAN, FNAPDean and Distinguished Foundation Professor in NursingCollege of NursingArizona State UniversityTempe, Arizona

Eduardo Ortiz, MD, MPHAssociate Chief of Staff, InformaticsVA Medical CenterWashington, D.C.

Kathleen C. Plum, RN, PhD, NPPDirector, Monroe County Office of Mental HealthRochester, New York

Cheryl Stetler, RN, PhD, FAANConsultant in EBPAmherst, Massachusetts

Kathleen Stevens, RN, EdD, FAANDirector and ProfessorAcademic Center for Evidence-Based NursingUniversity of Texas Health Science Center at San AntonioSan Antonio, Texas

Nancy Watson, RN, PhDDirector, Center for Clinical Research on AgingUniversity of Rochester School of NursingRochester, New York

Anne W. Wojner, RN, PhD, CCRNUniversity of Texas Medical SchoolHouston, TexasHealth Outcomes InstituteThe Woodlands, Texas

114 Third Quarter 2005 �Worldviews on Evidence-Based Nursing


TABLE 2Steps in the process of conducting the first U.S. EBP leadership summit and disseminating its outcomes

1. EBP experts and health care leaders throughout the United States were identified and invited to participate in the summit.a. The decision was made to involve leaders in evidence-based practice (EBP), an international EBP expert, policymakers, expert

practitioners, and clinical researchers in the summit.b. Summit goals were included in the invitation letters to the experts/leaders.

2. A pre-summit survey was conducted with the participants. For example: What are the priorities in your area of expertise that currentlyhave existing evidence to change practice, but the evidence is not widely implemented? (See Appendix for a sample of responses to thesurvey.)

3. The summit was convened.a. The vision and charge of the summit was shared with participants (co-chairs).b. The state of EBP in the United States was presented (co-chairs).c. The successes and challenges of advancing EBP in another country with a long-standing history of EBP were described

(international expert).d. Congruence with other ongoing EBP initiatives was established (participant in the Advancing Quality of Care Through Translation

Research invitational conference [Titler 2004] and U.S. Agency for Healthcare Research & Quality TRIP researcher).e. Small working groups were convened and given their charges (co-chairs).f. Recommendations of small working groups were shared with all summit participants.g. Summit participants prioritized and decided upon the three major recommendations with strategies for implementation to advance

EBP in the United States.4. Outcomes and recommendations from the summit were shared in a national forum (i.e., at the fifth annual EBP conference).5. A manuscript was written for the purpose of disseminating the summit recommendations through publication.

adoption of individual best practices based on research inany clinical setting. However, evidence from current re-search on the implementation of best practices along withgeneral findings about organizational change suggest thatcontextual elements are likely to influence the success orfailure of EBP efforts. Such elements include leadership, or-ganizational culture, and presence of organizational struc-tures and systems that support the routine use of EBP (e.g.,a collaborative environment, EBP mentors, and allocationof time to perform EBP).

If nurse executives and other health care leaders are toachieve the routine adoption of EBPs, they must under-stand the nature of evidence, the implementation process,organizational change, and key contextual elements. Thisrequires the availability of targeted programs or EBP men-tors as well as a change in educational curricula. Lead-ers can then apply that knowledge to creating an envi-ronment that is encouraging, supportive, and sustainingof EBP as routine practice. This includes a focus on boththe use of external (research) evidence and the generationand use of needed internal (local) evidence (Ciliska et al.2005).

Summit participants emphasized that development ofEBP mentors or information brokers was necessary tochampion EBP in their organizations. Although researchcourses are just now beginning to focus more explicitlyon EBP, many nurses have never had such education. Theavailability of an “EBP mentor,” as first proposed by theARCC model (Melnyk & Fineout-Overholt 2002; Fineout-Overholt et al. 2005), a knowledge broker, or an imple-

mentation facilitator within the practice setting is thereforerecommended. This individual requires not only knowl-edge of the change process, but also knowledge of changespecifically related to implementation of evidence. Further-more, actual implementation requires knowledge of clini-cal evidence and related decision-making processes. Thisrole suggests advanced practice education (e.g., a clinicalnurse specialist). Such an individual is often well preparedboth to play an advocacy role and to provide a rich learn-ing environment for staff around EBP. Nonetheless, giventhe evolving nature of the science of implementation, eventhese individuals often require additional preparation inEBP for this targeted role.

PRIORITIES FOR SYNTHESIZINGCLINICAL RESEARCH FINDINGS

Evidence synthesis is the heart of EBP (Stevens 2001).Although there are excellent guidelines for synthesiz-ing RCTs (i.e., Cochrane Handbook www.cochrane.dk/Cochrane/handbook/hbook.htm), there is a paucity of rig-orous methods for synthesizing non-RCT quantitative ev-idence. Sandelowski and Barroso (2003a, 2003b) havedeveloped rigorous methods for synthesizing qualitativeresearch. A next step toward establishing rigor for synthe-sizing non-RCT quantitative evidence is that those whohave influence in EBP need to adopt a level of rigor forsyntheses that is accountable to the public.

Clinical practice guidelines need to specify strength ofthe evidence supporting their recommendations. Haynes



TABLE 3Specific recommendations from the summit working groups

Priorities and Strategies to Accelerate theTranslation of Research Findings IntoPractice

1. Establish partnerships between researchers and health care organizations so that theright evidence is generated to guide best practice.

2. Educate health care leaders on how to create an infrastructure and culture to supportEBP.

3. Develop “EBP mentors”/information brokers who will champion EBP in theirorganizations.

Priorities for Synthesizing Clinical ResearchFindings

1. Develop a rigorous method for synthesizing descriptive and non-randomized controlledtrial (non-RCT) evidence.

2. Develop a standard that all clinical practice guidelines should specify strength ofevidence supporting their recommendations.

Priorities for Clinical Research 1. Form a national research/EBP network as a strategy to rapidly accelerate the conduct ofexperimental and other types of studies that can generate evidence to guide clinicalpractice and improve patient outcomes.

2. Conduct dissemination–implementation studies once interventions are supported asefficacious through RCTs.

Strategies for Overcoming Barriers inImplementing EBP

Regarding practitioners/practice systems:1. Include a commitment to EBP in the philosophy of every care system.2. Invest in and implement clinical information and decision support tools/systems in

practice arenas.3. Experiment with innovative delivery systems (group visits, Web interventions, team

practice [MDs/NPs/PAs]).4. Provide incentives for the use of EBP through loan forgiveness to providers, or tax

breaks to care systems/different reimbursement rates for EBP tied to specifiedoutcomes (change reimbursement systems to reward EBP).

Regarding practitioner education:1. Integrate EBP content/practice in curricula of all health professions.2. Include content on EBP in licensure and certification examinations.3. Include EBP content within requirements of national educational program accrediting

bodies.Regarding evidence:

1. Create a National Center for EBP or Clinical Knowledge Engineering to serve as aclearinghouse on best practices, guidelines, methods to implement EBP.

2. Dedicate 30% of the NIH budget to research on health promotion/disease prevention(effective interventions, effective implementation strategies).

and colleagues (1995) indicated that guidelines that arerigorously and explicitly developed can help narrow thechasm between scientific evidence and clinical decisionmaking. For guidelines to be used consistently, furtherfunding for testing EBP guidelines is needed.

PRIORITIES FOR CLINICAL RESEARCH

There is an urgent need for nurse researchers to developand test interventions that promote the highest level ofhealth across the age span. For example, there is a paucity ofintervention studies that have been conducted in primarycare settings, an arena that is ripe for the testing of briefinterventions to enhance both physical and mental healthin diverse populations. There continues to be descriptivestudies being conducted in substantive areas where there is

ample evidence to guide the development of interventionsto improve clinical care and patient outcomes. As such,there is an urgent need to develop skilled researchers whoconduct multidisciplinary experimental studies. Doctoralprograms should place greater emphasis on interventionresearch and encourage students to conduct pilot RCTs inareas that are ripe for experimental studies. Encouragingpartnerships between academicians and master’s preparedclinicians to conduct more pilot RCTs would be beneficialin stimulating an accelerated movement of interventionwork.

Because many areas of nursing practice still do nothave solid evidence to support them, there is a needto rapidly produce evidence through a national networkof researchers and clinicians. Not only would a nationalnetwork of investigators and sites facilitate rapid data



collection, but it also would enhance the generalizabilityof study findings.

There is a paucity of dissemination/implementationstudies in the nursing field (e.g., the process throughwhich interventions that have been supported as effica-cious through RCTs are best transported to clinical prac-tice settings). Since it takes an average of 17 years to trans-late the findings from research studies into practice (Balas& Boren 2000), accelerated efforts to study the processesthrough which evidence-based interventions are diffusedand used in clinical practice are necessary to speed theirtranslation (e.g., what are the barriers and facilitators thatfacilitate use of interventions by clinicians?). Once effi-cacy RCTs are conducted, it is imperative to conduct ef-fectiveness trials to learn the best methods for disseminat-ing/implementing the interventions into clinical practicesettings throughout the country.

STRATEGIES FOR OVERCOMINGBARRIERS TO EBP

Major barriers to EBP can be grouped into three sub-stantive areas: (a) practitioners/providers, (b) practice sys-tems/organizations, and (c) the state of evidence.

Practitioners or providers are most challenged by lackof time to deliver evidence-based care (Yarnall 2003) andlack of knowledge or skills training in the elements of EBP(Whitlock et al. 2002; Jennings 2004). Providers commit-ted to EBP often do not have the time to update care pro-tocols, update guidelines, and/or search for the latest evi-dence. As the health care system has changed over the pastdecade, clinicians are faced with expectations for produc-tivity as well as the implementation of evidence-based carestandards, such as implementing the new recommenda-tions for depression screening in adults (Berg et al. 2002).Another barrier is the fact that concepts of EBP are notcurrently on medical or nursing licensure examinations.Furthermore, health profession educational programs areonly beginning to include content on EBP, evidence synthe-sis, guideline development, as well as use and strategies forthe incorporation of evidence-based interventions withinclinical practice (Allan et al. 2004).

Practice systems/organizations impede the incorporationof EBP because of lack of decision support and informa-tion systems, continuous quality/evaluation processes, andphilosophical commitment. Studies (Solberg et al. 1998;2000) have demonstrated the efficacy of clinical decisionsupport systems in the successful implementation of EBP inprimary care practices. Using a patient reminder system andflagged reminders on charts improved preventive servicesprovided to patients. Studies indicate that the care systemsthat provide monthly reports to providers about how their

care met or did not meet cost and quality standards im-prove the incorporation of evidence into care (Solberg et al.2000; Whitlock et al. 2002). Another barrier is that reim-bursement systems in the United States do not typicallyreward health promotion/disease prevention, chronic caremanagement systems, or EBP.

Lack of evidence, poor evidence, and conflicting evidenceor guidelines operate as yet another barrier to the adoptionand implementation of EBP (Woolf et al. 1999). Moving toan evidence base for practice is limited by guidelines or rec-ommendations that are not usable by practitioners. Theseguidelines are either not written in a form for easy absorp-tion or are not tailored to the provider’s specific patientpopulation or context of care. For example, the UnitedStates Preventive Services Task Force found that screen-ing adults for depression was effective in care systems thathave high-quality assessment/treatment services to whichthe provider could refer a patient (Berg et al. 2002). Many ofthe conditions or diseases seen by providers lack evidence-based guidelines for care (e.g., physical activity, family andintimate partner violence, healthy diet). In-depth discus-sion of these barriers led to the recommendations listed inTable 3.

SUMMARY AND FINALRECOMMENDATIONS WITH

IMPLEMENTATION STRATEGIES

Following the small working group discussions, recom-mendations from each of the groups were shared with allsummit participants. After further discussion, the groupdecided upon the three highest priorities for advanc-ing EBP and formulated an implementation plan of howbest to advance EBP in the United States (see Table 4).These recommendations and implementation strategieswere shared with the participants who attended the fifthnational EBP conference during a panel presentation bysummit members. Initiatives are currently underway to ac-complish the strategic plan set forth by this EBP leadershipsummit.

In summary, although the advancement of EBP in nurs-ing throughout the United States has been relatively slow,national initiatives and collaborations such as this firstEBP Leadership Summit are critical for accelerating theparadigm shift. This commentary has described the pro-cess and outcomes of the first U.S.-based EBP LeadershipSummit, which may serve as a template for other coun-tries across the globe that desire to conduct similar forumsto advance EBP. Plans for future EBP leadership summitsacross specialty areas and for a formal U.S. consortium forEBP are currently underway to improve nursing care andpatient outcomes for diverse populations.



TABLE 4Top priorities for advancing EBP in the United States with implementation strategies

1. Form a national EBP/research consortium or network of institutions that facilitate the conduct of efficacy and effectiveness studies.� Write a concept paper that outlines the strategy to develop the national network.� Pursue funding for this national EBP/research consortium.� Meet with key individuals from The Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health/National

Institute of Nursing Research, to discuss potential funding and peruse current priorities for specific funding opportunities.2. Implement a national EBP mentorship program.

� Establish a national consortium/partnership among established EBP centers of excellence and national organizations.� Develop a list of EBP expert mentors.� Design the criteria for applications.� Plan the EBP mentorship experience.� Designate outcomes from the mentorship program.

3. Develop standards for education at all levels to integrate EBP.� Partner with the American Association of Colleges of Nursing (AACN), the National Organization of Nurse Practitioner Faculties

(NONPF), and the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) to develop standards.� Propose that EBP standards be a part of accreditation for professional schools and health care organizations.� Publish an EBP curriculum guide for all levels of education.

APPENDIX. Pre-summit questions withselected key responses

1. What are the priorities in your area of expertise thatcurrently have existing evidence to change practice,but the evidence is not widely implemented?Acute/Critical Care

– Suctioning without saline instillation– Open family visitation– Head-of-bed positioning for neuroscience pati-

entsAging

– Pain assessment and management in the elderly– Environmental assessment in dementia– Non-pharmacological interventionsChildren and Youth

– Screening for maternal depression and psychosocialmorbidities in pediatric primary care

– Nurse-home visitation with high-risk pregnantwomen

– Interventions for low-birth-weight premature in-fants, critically ill young children, and parents

Adult Health

– Obesity interventions– Self-management of symptoms in chronic illness– Pharmacological management of hypertensionPsychiatric Mental Health

– Functional family therapy– Psychopharmacological practices– Behavioral therapies

2. What strategies are necessary to rapidly acceler-ate the translation of clinical research findings intopractice?

– Widespread use of advanced practice nurses as“knowledge brokers/EBP mentors” to role modeland teach EBP in a variety of clinical settings

– Education and behavioral skills building in EBP– Administrative support and resources (e.g., Web-

based tools)– Widespread dissemination efforts of pre-appraised

evidence and clinical practice guidelines– Establishing EBP as the standard of care and in-

corporating it into competencies and promotioncriteria

– Health policy and insurance mandates– National/international networks of research/EBP

among health care organizations, educational insti-tutions, and clinical settings

– High-quality clinical practice guidelines– Randomized controlled trials to generate evidence

regarding which strategies are most effective fortranslating research evidence into practice

– Organizational change strategies– Professional organization and accreditation agen-

cies mandating EBP as standard of performance andeducation

– Change in insurance reimbursement– Incentives for implementing EBP– Education of clinical researchers in translation re-

search– Teaching EBP skills in educational curriculums

across all levels3. Identify three facilitators that may assist in the trans-

lation of research into practice.

– Increased health consumer knowledge– Strong champions in health care systems



– Evidence on cost savings with EBP implementationmodels

– A national/international network of EBP mentors– Funded centers that focus on translation research– Knowledge brokers/EBP mentors in health care

systems– Organizational support and EBP standards– Policymakers valuing EBP– Use of technology with decision support– Financial incentives– System changes, such as training programs, data

gathering and quality assessment, and use of infor-mation technologies

4. Identify barriers that may hinder the translation ofresearch into practice.

– The nursing shortage– Attitudes toward change– Time– Limited resources– A shortage of EBP mentors/knowledge brokers in

clinical settings and academic institutions– Lack of funding for translational research– Organizational cultures– Insurance reimbursement– Old paradigms regarding the teaching of research

5. Identify strategies that may be successful in over-coming the identified barriers.

– Recognize, reward, and encourage professionalgrowth in EBP

– A national network of champions/collaboratorscommitted to advancing EBP

– Designated EBP mentors in health care organiza-tions

– Increased funding for EBP implementation projectsand translational research

– Enhanced clinician education in EBP skills– A paradigm shift from teaching traditional research

in educational curriculums for baccalaureate andmaster’s students to teaching EBP knowledge andskills

– Commitment of those in key leadership positions– Link to Magnet award criteria– Publishing the results of research/EBP implementa-

tion projects in a relatable language, so findings canbe translated into clinical practice

6. Identify and describe three innovative strategies fortranslating research into practice.

– Build reward systems in health care settings that rec-ognize bedside nurses as clinical scholars or EBPpractitioners

– Hire EBP mentors/knowledge brokers in health caresystems

– A national network of EBP mentors– Training on the economic side of health research– Partner with industry and foundations– License re-examination for currency– Foster outcomes management– Develop personal digital assistant (PDA) pro-

grams specific to clinical populations/settingsthat contain EBP recommendations and guide-lines

– Educate consumers– Educate academicians in how to teach EBP– Encourage funding organizations to explicitly fund

translation research and outcomes managementprojects

7. Identify innovative strategies for accelerating EBP ineducational programs.

– Build faculty–practice partnerships aimed at show-casing EBP

– Require EBP as a competency for graduation in alllevels of education

– Educate faculty to be innovative teachers of EBPknowledge and skills

– Incorporate EBP requirements in every didactic andclinical course

– Educate students in how to use pre-appraised infor-mation for quick access

– Legislative mandates– Rewards for EBP teaching– Involve students in guideline development and

other EBP projects– Link students at all levels with EBP/research mentors– Have accreditation bodies require the development

of evidence-based curricula– More EBP collaborative partnerships between grad-

uate programs and health care institutions8. Identify and describe innovative strategies for trans-

lating research into health policy.

– Showcase research produced to stakeholders/policymakers

– Measure economic outcomes associated with EBPversus traditional practice

– Engage the media in building consumer knowledgeof EBP

– Sponsor statewide forums and collaborative partner-ships with policymakers

– Form collaborations among major professional or-ganizations to influence the political agenda to in-clude EBP and research outcomes

– Assist policymakers in basing legislation on the bestavailable evidence

– Identify more high-profile advocates to address leg-islators/policymakers



– Collaborate with effective lobbying groups aroundselected conditions/diseases to advocate forresearch-based policy

– Convene a summit meeting with policymakers

Note: Individuals who responded to these pre-summitquestions included all summit participants as well as Pa-tricia Grady, RN, PhD, FAAN, director of the National In-stitute of Nursing Research.

AcknowledgmentsThe authors thank the Center for Research & Evidence-Based Practice at the University of Rochester School ofNursing and the Helene Fuld Health Trust, HSBC Bank,United States, for their support of this summit as well asthe Agency for Healthcare Research and Quality (AHRQ)and Sigma Theta Tau International for sponsoring repre-sentatives to attend this meeting. Appreciation is also ex-tended to all summit attendees for their participation inthis landmark event.

ReferencesAllan J., Barwick T.A., Cashman S., Cawley J.F., Day C.,

Douglass C.W., et al. (2004). Clinical prevention andpopulation health: Curriculum framework for healthprofessions. American Journal of Preventive Medicine,27(5), 471–476.

Balas E.A. & Boren S.A. (2000). Managing clinical knowl-edge for healthcare improvements (pp. 65–70). Germany:Schattauer Publishing.

Berg A., Allan J., Frame P., Homer C., Johnston M.,Klein J., et al. (U.S. Preventive Services Task Force).(2002). Screening for depression: Recommendationsand rationale. Annals of Internal Medicine, 136(10), 760–764.

Ciliska D., DiCenso A., Melnyk B.M. & Stetler C. (2005).Using models and strategies for evidence-based practice.In B. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare. A guide to best prac-tice (pp. 185–219). Philadelphia: Lippincott Williams &Wilkins.

Committee on Quality of Health Care in America. (2001).Crossing the quality chasm: A new health system for the21st century. Washington, DC: National Academy Press.

Cretin S., Farley D.O., Dolter K.J. & Nicholas W. (2001).Evaluating an integrated approach to clinical quality im-provement: Clinical guidelines, quality measurement,and supportive system design. Medical Care, 39(8, Suppl.2), II70–II84.

Dawes M. (1996). On the need for evidence-based gen-eral and family practice. Evidence-Based Medicine, 1, 68–69.

Fineout-Overholt E., Levin R.F. & Melnyk B.M. (2005).Strategies for advancing EBP in clinical settings. Journalof the New York State Nurses Association.

Greiner A. & Knebel E. (2003). Health professions edu-cation: A bridge to quality. Washington, DC: NationalAcademies Press.

Haynes R.B., Hayward R.S.A. & Lomas J. (1995). Bridgesbetween health care research evidence and clinical prac-tice. Journal of the American Medical Informatics Associ-ation, 2(6), 342–350.

Heater B., Becker A. & Olson R. (1988). Nursing interven-tions and patient outcomes: A meta-analysis of studies.Nursing Research, 37(5), 303–307.

Jennings C. (2004). Translational research: Disrupting thestatus quo. Nursing Outlook, 52(1), 66.

Jolley S. (2002). Raising research awareness: A strategy fornurses. Nursing Standard, 16(33), 33–39.

Melnyk B.M. & Fineout-Overholt E. (2002). Putting re-search into practice. Rochester ARCC. Reflections onNursing Leadership, 28(2), 22–25.

Melnyk B.M. & Fineout-Overholt E. (2005). Evidence-based practice in nursing & healthcare: A guide to bestpractice. Philadelphia: Lippincott Williams & Wilkins.

Melnyk B.M., Fineout-Overholt E., Feinstein N.F., Li H.,Small L., Wilcox L. & Kraus R. (2004). Nurses’ per-ceived knowledge, beliefs, skills, and needs regardingevidence-based practice: Implications for acceleratingthe paradigm shift. Worldviews on Evidence-Based Nurs-ing, 1(3), 185–193.

Omery A. & Williams R.P. (1999). An appraisal of researchutilization across the United States. Journal of NursingAdministration, 29(12), 50–56.

Sandelowski M. & Barroso J. (2003a). Creating metasum-maries of qualitative findings. Nursing Research, 52(4),226–233.

Sandelowski M. & Barroso J. (2003b). Toward a metasyn-thesis of qualitative findings on motherhood in HIV-positive women. Research in Nursing & Health, 26(2),153–170.

Solberg L., Kottke T., Brekke M., Conn S., Magnan S. &Amundson G. (1998). The case of the missing clinicalpreventive services systems. Effective Clinical Practice,1(1), 33–38.

Solberg L., Kottke T., Brekke M., Magnan S., Davidson G.,Calomeni C., et al. (2000). Failure of a continuous qual-ity improvement intervention to increase the delivery ofpreventive services. Effective Clinical Practice, 3(3), 105–115.

Stevens K.R. (2001). Systematic reviews: The heart ofevidence-based practice. AACN Clinical Issues: Ad-vanced Practice in Acute and Critical Care, 12(4), 529–538.



Thompson D.R. (2004). Evidence-based nursing in Asia:Enter the tiger. Worldviews on Evidence-Eased Nursing,1(3), 155–157.

Titler M.G. (2004). Overview of the U.S. invitational con-ference “Advancing quality care through translationresearch.” Worldviews on Evidence-Based Nursing, 1(3,Suppl 1), S1–S5.

Wallin L. & Ehrenberg A. (2004). Evidence-basednursing—Views from the Swedish horizon. Worldviewson Evidence-Based Nursing, 1(3), 158–161.

Whitlock E., Orleans C.T., Pender N. & Allan J. (2002).

Evaluating primary care behavioral counseling interven-tions: An evidence-based approach. American Journal ofPreventive Medicine, 22(4), 267–284.

Woolf S., Grol R., Hutchinson A., Eccles M. & GrimshawJ. (1999). Clinical guidelines: Potential benefits, limita-tions, and harms of clinical guidelines. British MedicalJournal, 318(7182), 527–530.

Yarnall K., Pollack K., Ostbye T., Krause K. & MichenerJ. (2003). Primary care: Is there enough time for pre-vention? American Journal of Public Health, 93, 635–641.


Documents

Outcomes and Implementation Strategies From the First U.S. Evidence-Based Practice Leadership Summit